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Placer County Human Resources Department
#2017-11779-01


Supplemental Questionnaire

Last Name First Name
 

 

Sexual Assault Response Team (SART) Nurse/Coordinator

Supplemental Questionnaire



 

Section I - Minimum Qualification Screening Questions (Not Scored):


1.

Do you possess the equivalent of an Associate of Science Degree or higher from an accredited university or college?

Yes No
 

If yes, what type of degree do you possess?

 

What was your major course of study?

2.

Do you possess a valid California license as a Registered Nurse?

Yes No
 

If yes, please provide your license number and attach a copy of your license to your application.

3.

Do you possess two (2) years of post-license professional clinical experience in an acute care facility or a public health department specializing in Obstetrics & Gynecology, Pediatrics, Emergency Room, Intensive Care Unit, and/or Cardiac Care unit or a closely related medical field OR two (2) years of experience as a forensic examiner?

Yes No
 

If yes, please explain the experience you have (number of years, area(s) of specialization, duties).

4.

Do you possess valid California certifications for Basic Pediatric Sexual Assault Forensic Examiner (SAFE) for Healthcare Professionals and Adult Sexual Assault Forensic Examiner (SAFE) for Healthcare Professionals?

Yes
No, I would need to complete within 1 year of date of employment, if hired by Placer County.
 

If yes, please state when you attained the certifications.   And attach copies of your certifications to your application.


 

Section II - Examination (Scored):



 

This supplemental questionnaire will serve as the examination for this recruitment. It will be scored based on your checked responses below. Scores received from this examination will determine applicant ranking and placement on the eligible list.

By continuing in this examination process, you are certifying that all information provided in the supplemental questionnaire is true to the best of your knowledge.


 

I have read and I understand the above information.


 

For the following questions, select the one response that best describes your level of job-related experience and/or training. The narrative responses provided by applicants describing experience and/or training will not be scored but will be available to the hiring authority and may be utilized for interview and selection determinations.


1.

Professional nursing theory, practice, and techniques in the areas of sexual assault and associated trauma.

I have no or very limited experience with this knowledge and information.
I have some experience with this knowledge and information but would need additional training.
I have experience with this knowledge and information under close supervision.
I have experience with this knowledge and information under normal supervision.
 

If you have indicated experience, please explain how you have applied it.

2.

Principles and standards of forensic medical examination, as well as the use of legal terminology and medical and ethical responsibilities in SART examinations.

I have no or very limited experience with this knowledge and information.
I have some experience with this knowledge and information but would need additional training.
I have experience with this knowledge and information under close supervision.
I have experience with this knowledge and information under normal supervision.
 

If you have indicated experience, please explain how you have applied it.

3.

Completing specialized medical examinations and giving recommendations for follow-up care.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain the types of examinations you have completed and the recommendations you have made for follow-up care.

4.

Interviewing clients in trauma-focused situations.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain the information you have obtained and the methods you have used to receive it.

5.

Ensuring compliance with hospital and/or department goals, objectives, strategic plans, policies, and procedures.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain how you have ensured compliance.

6.

Ensuring HIPPA compliance as Custodian of Records, chain of custody, and document management.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain what documents you have managed and how you have ensured compliance with HIPPA and chain of custody protocols.

7.

Maintaining pharmaceuticals for SART patients and dispensing medication pursuant to SART protocol.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain it below. Note: If your pharmaceutical distribution experience is not specific to SART, please describe the pharmaceuticals you have maintained for patients.

8.

Serving as a liaison between different departments, organizations, and/or community groups, including the District Attorney's Office, Child Welfare Services, law enforcement, and local hospitals.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain the entities you have collaborated with, what programs you have developed, and what community outreach you have done.

9.

Conducting community outreach and providing technical training to various groups regarding sexual assault and/or physical abuse.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain the community outreach and training you have provided.

10.

Providing oversight and training to assigned staff.

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please describe the day-to-day guidance you have given, including recruiting, interviewing, training, and scheduling of assigned staff.

11.

Providing testimony during legal proceedings (i.e. depositions, court trials, and grand jury hearings).

I have no or very limited experience performing this task.
I have some experience performing this task but would need additional training.
I have experience performing this task under close supervision.
I have experience performing this task independently under normal supervision.
 

If you have indicated experience, please explain the testimony you have given and the legal proceedings involved.


 

Thank you for completing the examination portion of the application process. We encourage applicants to review their answers for accuracy prior to submitting.

Click "Save & Continue" to move forward to the next tab.

Be sure to select the "Submit" button once the application has been completed. You will receive a confirmation that the application has been submitted.

A notice of your status will be sent to you after the posted final filing date.